What is a likely consequence of using a nipple with a hole that is too large?

• A. Increased digestion
• B. Dehydration
• C. Leakage of formula and aspiration and pneumonia
• D. No effect

Answer: (C)

A too-large nipple hole speeds up the flow of formula, delivering it faster than the youngster can safely manage with its suck–swallow–breathe coordination. The result is formula leaking from the mouth and, more worryingly, aspirating into the airway. Once formula enters the lungs, it can cause an infection such as aspiration pneumonia. Dehydration isn’t the direct consequence here—it’s more likely if feeding is too slow or poorly tolerated—and increased digestion isn’t affected by hole size. The key risk with an oversized hole is the combination of leakage and the serious danger of aspiration leading to pneumonia.